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Polyanalgesic Consensus Conference 2012: Recommendations for the Management of Pain by Intrathecal (Intraspinal) Drug Delivery: Report of an Interdisciplinary Expert Panel

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  • For more information on author guidelines, an explanation of our peer review process, and conflict of interest informed consent policies, please go to http://www.wiley.com/bw/submit.asp?ref=1094-7159&site=1

  • Sources of financial support: This project was supported by grants from Medtronic, Inc. (Minneapolis, Minnesota, USA) and Azur Pharma Ltd (Dublin, Ireland).

  • Conflict of Interest: Timothy R. Deer, MD: consulting (Medtronic, Spinal Modulation, St. Jude, Medasys, Bioness, Vertos). Robert Levy, MD, PhD: consulting (Medtronic and Codman & Shurtleff). Joshua Prager, MD: honoraria (Medtronic, Eli Lily, Qutenza). Allen Burton, MD: consulting (Medtronic, BSCIS, Stryker), speaking (Azur, Cadence, Cephalon, NeurogesX, Pricara, Pfizer), stockholder (Vapogenix). Eric Buchser, MD: consulting (Medtronic). David Caraway, MD, PhD: consulting (Medtronic, Spinal Modulation, MedSys, Codman). Sudhir Diwan, MD: speaking (Neurotherm, BSCI). Eric Grigsby, MD: clinical research (Alfred Mann Foundation, Medtronic, NeurogesX, Spinal Restoration), speaking (Azur Pharma), consulting (Medtronic, St. Jude Medical, Spinal Modulation, Vertos, Xalud), stock options (Spinal Modulation, Spinal Restoration, Vertos, Xalud). Marilyn Jacobs, PhD: consulting (Medtronic). Philip Kim, MD: consulting (Medtronic, Biotronik, Stryker, Azur). Krishna Kumar, MD: consulting and research (Medtronic, Boston Scientific). Michael Leong, MD: advisor (Covidien). Liong Liem, MD: grant (Spinal Modulation). Gladstone McDowell, MD: speaking (Azur), consulting (Medtronic, Mysys). Nagy Mekhail, MD, PhD: speaking (Endo Pharmaceutical), research (Baylis, Inc., Vertos). Richard Rauck, MD: research (Medtronic, Medasys, Azur, Codman, Al Mann Foundation), consulting (Medtronic, Medasys, Azur), data and safety monitoring board membership (Medtronic, Al Mann Foundation). Michael Saulino, MD, PhD: speaking (Medtronic, Azur), research (Medtronic). Lisa Stearns, MD: research (Medtronic, Insys Therapeutics, Vertos), consulting (Medtronic). Mark Wallace, MD: research and consulting (Medtronic). K. Dean Willis, MD: speaking (Boston Scientific, Medtronic, St. Jude Medical), Implantable Systems Performance Registry participant (Medtronic), advisory committee (Boston Scientific). William Witt, MD: consulting (Medtronic), speaking (Cadence, Pfizer, Medtronic). José De Andrés, MD, PhD; Michael Erdek, MD; Marc Huntoon, MD, PhD; Sunil J. Panchal, MD; Peter Staats, MD; Michael Stanton-Hicks, MD; B. Todd Sitzman, MD; Michael Cousins, MD: nothing to disclose; and Tony Yaksh, PhD: consulting (Vertex, Adynxx, Solace, Neuroadjuvants, Trevana), research (Adynxx, Johnson & Johnson, Xenome, Torrey Pines, Third Rock Ventures, Advanced Targeting Systems, Nektar Pharma, Endo Pharmaceuticals, Sage Rx, Solstice, Epigen).

Timothy Deer, MD, Center for Pain Relief, 400 Court Street, Suite 100, Charleston, WV 25301, USA. Email: doctdeer@aol.com

Abstract

Introduction:  The use of intrathecal (IT) infusion of analgesic medications to treat patients with chronic refractory pain has increased since its inception in the 1980s, and the need for clinical research in IT therapy is ongoing. The Polyanalgesic Consensus Conference (PACC) panel of experts convened in 2000, 2003, and 2007 to make recommendations on the rational use of IT analgesics based on preclinical and clinical literature and clinical experiences.

Methods:  The PACC panel convened again in 2011 to update the standard of care for IT therapies to reflect current knowledge gleaned from literature and clinical experience. A thorough literature search was performed, and information from this search was provided to panel members. Analysis of published literature was coupled with the clinical experience of panel members to form recommendations regarding the use of IT analgesics to treat chronic pain.

Results:  After a review of literature published from 2007 to 2011 and discussions of clinical experience, the panel created updated algorithms for the rational use of IT medications for the treatment of neuropathic pain and nociceptive pain.

Conclusions:  The advent of new algorithmic tracks for neuropathic and nociceptive pain is an important step in improving patient care. The panel encourages continued research and development, including the development of new drugs, devices, and safety recommendations to improve the care of patients with chronic pain.

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